BalanceEar, Nose and ThroatHearing and Balance
Reviewed By Kristen Janky, Au.D, Ph.D., CCC-A
One assessment to determine which canal the otoconia are in,
if your patient has horizontal canal BPPV is to do the Bow and Lean maneuver. For the Bow and Lean maneuver you’re going to
first ask your patient to bow. So the
patient is going to bow forward with their nose facing the floor. In this instance, if the debris is in the
horizontal canal, it should fall forward towards the cupula and you should see
the nystagmus beat towards the affected side.
After the nystagmus has gone away, you’ll ask the patient to lean back
with their nose facing the ceiling. If
the debris is in the horizontal canal and its canalithiasis the debris should
fall away from the cupula and the nystagmus should be away from the affected
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